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Despite more than a decade of progress in the fight against malaria, there are some regions where rates are spiking. Estrella Lasry, tropical medicine advisor at Doctors Without Borders/Médecins Sans Frontières (MSF), discusses here how factors like conflict, climate, and insecticide resistance may play a role in the rise of malaria cases in countries like Democratic Republic of Congo, South Sudan, and Mali.

According to the World Health Organization, 214 million cases of malaria were reported in 2015, with 438,000 people dying from the mosquito-transmitted parasite. Ninety-one percent of these deaths occured in sub-Saharan Africa. Despite malaria mortality rates falling by 37 percent since 2000, a child in Africa still dies every minute from malaria.

Malaria is most common in poor, deprived areas. In many cases, malaria itself is the cause of such poverty: malaria causes havoc on a socioeconomic level as patients are often bedridden and incapable of carrying out normal daily tasks, resulting in burdens on households and health services, and ultimately huge losses to income in malaria-endemic countries.

This suffering and loss of life are tragically unnecessary because malaria is largely preventable, detectable, and treatable.

While 91 percent of malaria deaths occur in sub-Saharan Africa, the disease is present in nearly every tropical area where MSF carries out field programs: from Ethiopia and Sierra Leone to Myanmar.

Facts

Ninety percent of malaria deaths occur in children living in sub-Saharan Africa.

Malaria is most common in poor areas and is itself a cause of poverty.

Malaria is a parasitic infection transmitted by female mosquitoes.

Artemisinin-based combination therapy is the most effective treatment.

A course of anti-malarial pills for a baby can cost as little as $0.40.

What Causes Malaria?

Malaria is a parasitic infection transmitted from person to person by the bite of infected female Anopheles mosquitoes.

These mosquitoes usually bite from around dusk to dawn.

Once transferred to the human body, the infection travels to the liver where it multiplies and then enters the red blood cells.

Inside the red blood cells the parasites multiply rapidly until they burst, releasing even more parasites into the blood stream.

There are four main species of the malaria parasite: Plasmodium falciparum, Plasmodium malariae, Plasmodium vivax, and Plasmodium ovale.

P. falciparum is the main cause of severe clinical malaria and death.

Symptoms of Malaria

Malaria begins as a flu-like illness, with symptoms first occurring nine to 14 days after infection. Symptoms include fever (typical cycles of fever, shaking chills, and drenching sweats may develop), joint pain, headaches, frequent vomiting, convulsions, and coma.

If simple malaria is left untreated, it can become severe—around eight million malaria cases progress to severe malaria annually. Death from malaria may be due to brain damage (cerebral malaria), or damage to vital organs. The reduction of red blood cells can cause anemia.

Diagnosing Malaria

Diagnosing malaria is done with rapid dipstick tests or looking for the parasite under a microscope in a blood smear. However, rapid tests are not always available, microscopy is not always straightforward and, as a result, diagnosis based on symptoms is still normal in much of the developing world.

This means patients are often misdiagnosed and the real reasons for their symptoms go untreated. It also means antimalarial drugs are overused and go to waste when they are desperately needed.

Jacob Kuehn/MSF

An MSF mobile outreach worker goes door to door in Bentiu, South Sudan, providing children with malaria treatment.

Treating Malaria

The most effective treatment for malaria is artemisinin-based combination therapy (ACTs). ACTs have low toxicity, few side effects, and act rapidly against the parasite.

Today, 41 out of 54 African countries have officially changed their protocol to treat first-line malaria with ACTs. But in many places where MSF works, ACTs are scarcely available. The global need for ACTs is estimated to be at 300 to 500 million treatment courses per year, however, in 2006, drugs for less than 90 million treatments were purchased.

A three-day course of antimalarial pills for a baby can cost as little as $0.40.

Long lasting insecticide-treated bed nets are an important means of controlling malaria. In endemic areas, MSF distributes nets to pregnant women and children under the age of five, who are most vulnerable to severe malaria.

In 2015, MSF treated 2,229,200 malaria cases.

The MSF Access Campaign works to improve access to medicines and stimulate the development of urgently needed treatments. MSF Access Campaign.

An archive of MSF's scientific articles available free, with full text and in an easily searchable format. MSF Field Research website.